Prediabetes, a condition characterized by elevated blood sugar levels that are not high enough to be classified as diabetes, poses a significant health risk. The Centers for Disease Control and Prevention (CDC) warns that without intervention, many individuals with prediabetes may develop type 2 diabetes within five years. Additionally, prediabetes increases the risk of heart attack, eye and kidney complications, and certain cancers. Shockingly, an estimated 96 million adults in the United States have prediabetes, and 80% of them are unaware of their condition.
Researchers at the Center for Diabetes Research in Germany conducted a study to explore how weight loss could potentially induce remission in individuals with prediabetes. The study aimed to examine the mechanisms behind prediabetes reversal and its effects on long-term kidney and vascular function. The findings, published in The Lancet Diabetes & Endocrinology, contribute to the growing body of evidence demonstrating the impact of lifestyle and dietary patterns on metabolic function and the development or prevention of diabetes symptoms.
Unlike type 2 diabetes remission, which focuses on enhanced insulin secretion, prediabetes remission is characterized by improved insulin sensitivity and reduced visceral adipose tissue (VAT). The researchers analyzed the Prediabetes Lifestyle Intervention Study (PLIS) and compared the results with those of the Diabetes Prevention Program (DPP) study. The PLIS involved 1,160 participants who received either a control lifestyle intervention, a standard DPP-based intervention, or an intensified intervention for 12 months. The DPP study, conducted between 1996 and 1999, randomly assigned participants to receive a standard lifestyle intervention, metformin, or placebo.
Of the PLIS participants, 25.7% achieved a weight loss of 5% or more. Among these individuals, 43% experienced remission, while the remaining 57% did not respond to the intervention. Interestingly, there was no significant difference in weight loss between the two groups. However, those who achieved remission demonstrated a significant improvement in insulin sensitivity, while the non-responders did not. The researchers found that the responders had lost more abdominal fat, despite losing the same amount of overall body weight. Waist reduction thresholds were identified as 4.5 cm for women and 7.4 cm for men, which best predicted remission.
Experts emphasize the importance of fat loss in reversing prediabetes. Kimberly Gomer, a dietitian and nutrition director, explains that prediabetes is closely linked to belly fat and visceral fat. Losing belly fat reduces insulin resistance, improving blood sugar control. Kelsey Costa, a registered dietitian nutritionist, praises the study for investigating the metabolic complications associated with high VAT and providing evidence that significant reductions in VAT, particularly through weight loss, can improve insulin sensitivity and reverse prediabetes.
Although the study had limitations, such as using surrogate parameters for insulin sensitivity and secretion, the results correlated well with direct measurements. The researchers acknowledged that their findings may not apply to low-income countries with limited access to medical care, and the majority of participants in both studies were white, limiting the generalization of the results to other ethnic groups.
To prevent prediabetes and type 2 diabetes, experts recommend following a healthy plant-based diet, incorporating intermittent fasting, engaging in regular exercise, managing stress, and getting enough quality sleep. The study’s co-first author, Professor Reiner Jumpertz-von Schwartzenberg, suggests that remission should be the new therapeutic target for individuals with prediabetes, as it has the potential to minimize complications. Additionally, the prediabetes remission criteria developed in this study can serve as biomarkers for diagnosing prediabetes.